Serving Hamilton, Butler, Clermont & Warren Counties

Complaint / Grievance Form

Grievance

We take all complaints seriously. Your feedback helps us improve our services. All fields marked * are required.

Your Rights

You have the right to file a complaint without fear of retaliation. All complaints are reviewed by management and you will receive a written response within 5 business days. For urgent safety concerns, please call (513) 587-4923 immediately.

1Client Information

Full Name*

Date of Birth

Phone Number*

Email Address

Address

2Complaint Details

Date of Incident*

Type of Complaint*

Staff Member(s) Involved (if applicable)

Description of Complaint*

Desired Resolution

Has this been previously reported?

3Witness Information (if applicable)

Witness Name

Witness Phone

4Electronic Signature

By typing your full name below, you certify that the information provided is accurate to the best of your knowledge.

Electronic Signature (Type Full Name)*

Date*

Your submission will be sent securely to our team at [email protected]. A completed PDF copy will be available for download after submission.